Should a small suture abscess be popped?

Management of Suture Abscesses

Small suture abscesses should be drained via incision and drainage rather than simply "popped." 1

Definition and Identification

A suture abscess is a localized collection of pus that forms around surgical suture material due to infection. It presents as:

• Erythematous, warm, fluctuant area at the suture site
• Progressive, throbbing pain
• Possible systemic symptoms (fever, malaise)
• Visible suture material with surrounding purulence

Treatment Approach

Primary Management

1. Incision and drainage (I&D) is the recommended treatment for small abscesses including suture abscesses 1

   • Simple "popping" without proper drainage can lead to:
     • Incomplete evacuation of purulent material
     • Risk of spreading infection
     • Recurrence of abscess
     • Inadequate removal of the offending suture material

2. Proper I&D technique:

   • Clean the area with antiseptic solution
   • Use sterile technique
   • Make an adequate incision to allow complete drainage
   • Remove the infected suture material completely
   • Express all purulent material
   • Explore for loculations (pockets of pus)

Post-Drainage Care

• Simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound 1
• Some clinicians pack the wound with gauze, but one small study found that packing caused more pain and did not improve healing compared to just covering the incision site with sterile gauze 1
• Clean the wound with warm water/saline 2-3 times daily 2
• Consider sitz baths for perianal suture abscesses 2

Antibiotic Considerations

• Antibiotics are generally not required for simple, drained suture abscesses in immunocompetent patients 1, 2
• Consider antibiotics only if:
  • Patient has systemic inflammatory response syndrome (SIRS)
  • Presence of significant surrounding cellulitis
  • Immunocompromised patient
  • Inadequate source control 1, 2

Follow-up Care

• First follow-up should be within 48-72 hours after drainage 2
• Monitor for:
  • Complete resolution of the abscess
  • Signs of recurrent abscess formation
  • Delayed healing
  • Persistent infection 2

Common Pitfalls to Avoid

1. Inadequate drainage: Ensure complete evacuation of pus and removal of infected suture material
2. Failure to identify and remove the causative suture: The foreign body (suture) must be removed to prevent recurrence
3. Inappropriate antibiotic use: Antibiotics alone without drainage are ineffective for established abscesses
4. Premature closure of the drainage site: Allow adequate time for complete drainage
5. Neglecting underlying conditions: Consider factors that may predispose to poor healing

Special Considerations

• Deeper or larger suture abscesses may require more extensive surgical exploration
• Recurrent suture abscesses may indicate retained suture material or an underlying condition affecting healing
• Non-absorbable sutures (like silk or braided polyester) are more likely to cause suture abscesses than absorbable materials 3, 4

Remember that proper incision and drainage with complete removal of the infected suture material is the definitive treatment for suture abscesses, not simply "popping" them.